Monday Injury Rounds: Preseason Week 2

Injury Rounds

The volume of injuries last week wasn't high. But the severity certainly was.

Two teams saw their leading receivers go down with ACL tears. Kelvin Benjamin went down in a joint practice. Jordy Nelson in an early drive in his second preseason game. Both injuries were predictably followed by a barrage of indignation over the meaningless nature of preseason practices and games.

I get the angst. Benjamin and Nelson are much more important to their teams in mid-December than in mid-August. But I don't agree that these reps are meaningless. Players need to get acclimated to game speed and football related physical encounters. Do we need two preseason games or four? Do we need six weeks of preseason practices? I don't know the answer to that either. But I strongly believe players need to condition for live game action.

I do know that researchers -- and undoubtedly those examining the "sport science" data collected by NFL teams -- are aggressively searching for ways to prevent serious injuries like ACL tears. How much have changes in turf condition, the rise of speed shoes, the number of preseason reps, and/or differences in the condition of the stabilizing muscles around the knee play a role? It's hard to say and likely a combination of factors. But the NFL will continue to look for ways to protect their investments on the field.

For now, be reassured that surgical repair of ACL tears is associated with a high success rate. Both Benjamin and Nelson will have nearly 12 months of recovery time before next training camp. Recovery from major injury is never guaranteed, but it's reasonable to expect both wide receivers to be return in form next season.

Benjamin's ACL injury occurred some days ago and has been confirmed by the team. Nelson's injury occurred a few hours ago, and, as I write this Sunday evening, has yet to be confirmed. Don't take that as a sign of hope, however.

Sideline exams are very accurate in diagnosing sprained knee ligaments, especially the ACL and MCL, when performed by experienced medical staff personnel. It's extremely rare -- so rare I can't recall an example -- to hear about a structurally intact ligament after a reliable report expressing a team's concern about a torn ACL. There's no reason to doubt Ian Rapoport's source here.

So, why hasn't Nelson's injury been confirmed yet?

Diagnosing a torn ACL isn't an emergent medical situation. Believe it or not, NFL stadiums (with the exception of Cincinnati's Paul Brown Stadium) do not have CT or MR scanners. They are equipped with x-ray machines only. So, players have to be set up for a study in a local facility. On a weekend afternoon, that often means calling in a technician and ensuring staff are around to read the scans. If the medical staff was worried about a nerve or vessel injury, those scans would happen immediately.

But there's no difference to the ultimate treatment plan by confirming a diagnosis of a torn knee ligament on a weekend evening versus the following day. Players routinely wait until early Monday morning for imaging studies during the regular season. Expect the Packers to treat Nelson's situation similarly.

And the MRI is confirmation of what's already been diagnosed by exam. More importantly, the MRI will show whether there are any additional injuries -- MCL sprains, meniscus tears, etc. -- that may change the treatment in the days before surgery or inform the surgeon of other injuries to be addressed during the ACL repair.

Until the MRI, hold onto a sliver of hope for Nelson if you like. But you should fully expect to hear the diagnosis of a torn ACL to be confirmed on Monday.

The Falcons have been the most underreported team in the league for years. It's fascinating for such a large city and fan following. But there's hardly ever anything of note about the team published and you can forget about getting any detailed information about injuries unless it's significant enough to be chased by a major media member. Even trying to parse the snippets of information on Julio Jones and his hip injury last season was like figuring out a crossword puzzle with only half the clues.

A few days ago, the local media reported White as having a shoulder injury. They then amended that to an elbow injury, which was of no concern. Now, White will presumably have arthroscopic surgery this week for what's being called loose particles in his elbow joint. Coach Dan Quinn told reporters White would certainly be back for Week 1.

The timetable for White (2-3 weeks) matches most arthroscopic cleanout procedures. But his practice time leading up to Week 1 needs to be monitored closely.

emmanuel sanders | hamstring strain | week-to-week

Here's why the first 7-10 days after returning from a muscle strain are so critical.

Sanders missed time early in camp with what was by all accounts a minor hamstring strain. Shortly after his first full workout in preparation for the team's first preseason game, Sanders again felt "soreness" in his leg and was shut down again. He's been limited since. Aggravations can be worse than the original injury, which puts a mid-grade injury in play for Sanders. Those strains often need 3-4 weeks of recovery time. If Sanders isn't back doing individual drills soon, it's possible we won't see him for the rest of the preseason. And he'll again have to navigate that all-important 7-10 days of re-conditioning without another setback.

Maurkice Pouncey | ankle | month-to-month

Pouncey suffered yet another lower leg injury after getting rolled up on, this time an ankle injury that will require surgery. The mechanism on video shows a severe high ankle sprain, which often includes a break to the outer leg bone (fibula) near the ankle joint. There are unsourced reports suggesting Pouncey may be able to return in midseason, which would be 10-12 weeks from now. That timetable could be met if Pouncey's injury includes only the high ankle sprain and broken fibula.

The mechanism of injury was also worrisome for a tibia injury, however, and that would extend Pouncey's recovery time. Mike Tomlin wouldn't answer questions about Pouncey's timetable, saying the team wanted to wait until after the surgery. Hopefully, there are no additional injuries and Pouncey will be able to return later this season.

Follow-Up Appointments

There isn't much to report on this group this week. Teams are still multiple weeks from having to decide whether players still needing multiple weeks to recover will go on PUP or injured reserve-return or having to provide the league with more detailed injury reports.

It's hard to know whether no news is good news with Arian Foster. On one hand, there's no reason to expect the Texans to update Foster's condition. They don't have to decide his active roster status for at least another week. On the other hand, it would be nice to hear that Foster was ahead of schedule in his rehab -- if that's indeed the case -- and was likely to make the active 53 man roster to begin the regular season.

We'll get an update on Foster soon. For now, I still think he avoids IR-return and could be ready around Week 4, give or take a week in either direction. I'd like to see the Texans give him 4-5 weeks to recover and rehab, then put him through 1-2 weeks of reconditioning.

It's absolutely not a surprise Jeffery has yet to return to practice. There was nothing about Jeffery condition consistent with a day-to-day injury -- unless you consider missing a week and a half of practice and game action as nine separate day-to-day absences.

The Bears are still expecting to have Jeffery available for Week 1 and we've seen him play effectively even when hobbled by muscle strains. But it'd be nice to see him back to individual drills this week and reconditioning himself for a return. If his absence stretches into the middle of this week, I think a four week absence is possible. It's a big week for Jeffery.

breshad perriman | PCL sprain | week-to-week

Perriman's diagnosis changed again last week, with John Harbaugh revealing that Perriman's MRI (which was originally reported as "normal" despite noting some swelling around the knee) showed a PCL sprain. Last week, I speculated Harbaugh's comments about a bone bruise and strained tendon may have meant Perriman had a patellar tendon strain. That's obviously less likely the case now, though all three conditions we've heard connected with Perriman can occur with a direct hit to the front of the knee and hyperextension.

PCL sprains can be tricky to diagnose without imaging. Players will sometimes feel their knee isn't completely right or stable when they cut on it. The swelling and exam isn't often specific. So, it wouldn't be too unusual to see a player undergo an MRI later in the process as Perriman has. The difficulty here is healing. Sometimes the PCL (and surrounding structures in the back corner of the knee) don't heal as well as hoped and there can be some residual pain, swelling, or changes in range of motion. If that's what's happening with Perriman -- and the swelling and soreness persisting after 2-3 weeks is worrisome here -- the recovery time can drag on longer than hoped.

As of midweek, the Ravens expected Perriman to practice soon. Hopefully, we'll see that prove true this week.

Around the Training Table

I'm also watching to see if Victor Cruz (calf) returns to practice this week. Marquess Wilson has a hamstring strain. Larry Warford (G-Minnesota) and Ryan Kalil (C-Carolina) both suffered injuries during last weekend's preseason games. Warford may have trouble recovering by Week 1 with a high ankle sprain. The extent of Kalil's knee injury isn't yet known. Giants' middle linebacker Jon Beason suffered a knee sprain that could keep him out multiple weeks. Carolina defensive end Frank Alexander tore his Achilles' tendon.

Check back for more injury analysis throughout training camp and the regular season. Also, follow on Twitter @JeneBramel for breaking injury news, commentary and analysis of this injury and others around the NFL.